Aminoglycosides and glycopeptides: mechanism, dosing and toxicity
How gentamicin and vancomycin kill bacteria, why aminoglycosides are given once daily and vancomycin is dosed to an AUC, and the mechanisms behind nephrotoxicity, ototoxicity, neuromuscular blockade and vancomycin infusion reactions.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Aminoglycosides (gentamicin, tobramycin, amikacin) bind the 30S ribosome, cause misreading and kill gram-negative bacilli fast. Killing is concentration dependent with a post-antibiotic effect, so one large daily dose works best.
- Glycopeptides (vancomycin, teicoplanin) bind the D-Ala-D-Ala end of cell wall precursors. They cover gram-positives only, kill slowly, and efficacy tracks AUC/MIC.
- Both are polar, renally cleared drugs with a small volume of distribution (about 0.25 to 0.7 L/kg). Renal function and fluid shifts drive dosing.
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Sources
- Therapeutic Guidelines: AntibioticAU/NZTherapeutic Guidelines Limited
- Australian Medicines HandbookAU/NZAustralian Medicines Handbook Pty Ltd, 2026
- Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: a revised consensus guideline (ASHP, IDSA, PIDS, SIDP)American Journal of Health-System Pharmacy (Rybak et al.), 2020
- Goodman & Gilman's The Pharmacological Basis of Therapeutics (14th ed.)McGraw Hill (Brunton and Knollmann, 2023), 2023
- Last updated
- 14 November 2026
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